The Effect of Chemotherapy for Malignancy on the Natural History of Aortic Aneurysm

Abstract

Surgical dogma holds that chemotherapy increases the risk of aneurysm growth and rupture. We sought to determine the effect of cytotoxic chemotherapy on the growth of aortic aneurysms. All patients undergoing chemotherapy for malignancy with coexisting aortic aneurysms at our institution between 2000 and 2011 were identified. A review of electronic medical records and a re-review of serial cross-sectional imaging was performed. An additional cohort of patients undergoing aneurysm surveillance during the same period was identified, and demographic and anatomic variables were collected. Planned analysis included descriptive analysis, change in aneurysm diameter over time, and association of growth or need for intervention with type of chemotherapy and type of malignancy. Between 2000 and 2010, there were 125 patients at our institution with a concurrent diagnosis of aortic aneurysm and malignancy requiring cytotoxic chemotherapy. Cross-sectional imaging was available for 91 of the 125 patients. The predominant malignancy type was lung cancer in 34 of 91 patients (38%), followed by lymphoma in 21 (23%) and colorectal cancer in 10 (11%). The aneurysms in 53 patients (58%) were infrarenal. Most patients were treated with more than one class of chemotherapeutic agent over 267 days (interquartile range [IQR], 144-469 days), the majority having at least one cycle of alkylating agents (73 of 91), in addition to antimetabolites (42 of 91) and plant alkyloids/terpenoids (40 of 91). Chemotherapy regimens included steroids in 84 patients (92%). The baseline aneurysm diameter for patients on and not on chemotherapeutic agents was 41.4 mm (IQR, 34.9-51.3 mm) and 46.0 mm (IQR, 40-52 mm), respectively. Aneurysm repair during chemotherapy occurred in eight of 91 patients (9%), but only two required urgent repair due to aneurysm rupture. The annual rate of aneurysm growth for patients on and not on chemotherapy was similar (2.3 mm/y vs 2.4 mm/y; P = .69). In 91 patients over 10 years at our institution, chemotherapy did not increase aneurysm growth compared with patients not undergoing treatment for malignancy.